NURS 5463 Exam 3 V3 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heparin therapy for DVT develops a 50% drop in
platelet count on day 5. What is the most appropriate first action?
A. Immediately discontinue all heparin products
B. Switch to low molecular weight heparin (LMWH)
C. Perform a platelet transfusion
D. Wait for 4T score results before intervention
Answer: A
Rationale: Heparin-Induced Thrombocytopenia (HIT) is a clinical diagnosis characterized
by a significant drop in platelets after heparin exposure. The first priority is to stop all
heparin to prevent further immune-mediated thrombotic complications. Alternative
anticoagulation like Argatroban should be initiated once HIT is suspected.
2. A patient with acute kidney injury presents with a serum potassium of 6.8 mEq/L and
peaked T-waves on ECG. Which medication should be administered first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin and Dextrose
,C. Calcium Gluconate
D. Albuterol nebulizer
Answer: C
Rationale: Calcium gluconate is the first-line treatment for hyperkalemia with ECG
changes because it stabilizes the cardiac membrane. While insulin and dextrose help shift
potassium into cells, they do not provide immediate cardiac protection. Sodium
polystyrene sulfonate is used for potassium removal but acts too slowly for emergent
stabilization.
3. A patient is admitted with hematemesis and a suspected esophageal variceal bleed. Which
pharmacological agent is most appropriate to reduce portal venous pressure?
A. Pantoprazole
B. Metoclopramide
C. Octreotide
D. Lactulose
Answer: C
Rationale: Octreotide is a somatostatin analog that causes splanchnic vasoconstriction,
thereby reducing portal pressure. It is specifically indicated for active variceal bleeding in
cirrhotic patients to improve endoscopic success. Pantoprazole is used for peptic ulcers but
does not address portal hypertension directly.
, 4. Which finding is most diagnostic for disseminated intravascular coagulation (DIC) in a
septic patient?
A. Isolated thrombocytopenia
B. Prolonged PT with normal PTT
C. Elevated D-dimer and low fibrinogen
D. Presence of target cells on smear
Answer: C
Rationale: DIC involves widespread activation of coagulation followed by secondary
fibrinolysis, leading to the depletion of clotting factors. Laboratory hallmarks include
elevated D-dimer levels and decreased fibrinogen due to consumption. These findings,
combined with thrombocytopenia and prolonged PT/PTT, confirm the systemic nature of
the coagulopathy.
5. A 55-year-old female with cirrhosis presents with abdominal pain and fever. Paracentesis
shows an absolute neutrophil count (ANC) of 300 cells/mm3. What is the diagnosis?
A. Viral Hepatitis
B. Hepatorenal Syndrome
C. Biliary Colic
D. Spontaneous Bacterial Peritonitis (SBP)
Answer: D
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heparin therapy for DVT develops a 50% drop in
platelet count on day 5. What is the most appropriate first action?
A. Immediately discontinue all heparin products
B. Switch to low molecular weight heparin (LMWH)
C. Perform a platelet transfusion
D. Wait for 4T score results before intervention
Answer: A
Rationale: Heparin-Induced Thrombocytopenia (HIT) is a clinical diagnosis characterized
by a significant drop in platelets after heparin exposure. The first priority is to stop all
heparin to prevent further immune-mediated thrombotic complications. Alternative
anticoagulation like Argatroban should be initiated once HIT is suspected.
2. A patient with acute kidney injury presents with a serum potassium of 6.8 mEq/L and
peaked T-waves on ECG. Which medication should be administered first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin and Dextrose
,C. Calcium Gluconate
D. Albuterol nebulizer
Answer: C
Rationale: Calcium gluconate is the first-line treatment for hyperkalemia with ECG
changes because it stabilizes the cardiac membrane. While insulin and dextrose help shift
potassium into cells, they do not provide immediate cardiac protection. Sodium
polystyrene sulfonate is used for potassium removal but acts too slowly for emergent
stabilization.
3. A patient is admitted with hematemesis and a suspected esophageal variceal bleed. Which
pharmacological agent is most appropriate to reduce portal venous pressure?
A. Pantoprazole
B. Metoclopramide
C. Octreotide
D. Lactulose
Answer: C
Rationale: Octreotide is a somatostatin analog that causes splanchnic vasoconstriction,
thereby reducing portal pressure. It is specifically indicated for active variceal bleeding in
cirrhotic patients to improve endoscopic success. Pantoprazole is used for peptic ulcers but
does not address portal hypertension directly.
, 4. Which finding is most diagnostic for disseminated intravascular coagulation (DIC) in a
septic patient?
A. Isolated thrombocytopenia
B. Prolonged PT with normal PTT
C. Elevated D-dimer and low fibrinogen
D. Presence of target cells on smear
Answer: C
Rationale: DIC involves widespread activation of coagulation followed by secondary
fibrinolysis, leading to the depletion of clotting factors. Laboratory hallmarks include
elevated D-dimer levels and decreased fibrinogen due to consumption. These findings,
combined with thrombocytopenia and prolonged PT/PTT, confirm the systemic nature of
the coagulopathy.
5. A 55-year-old female with cirrhosis presents with abdominal pain and fever. Paracentesis
shows an absolute neutrophil count (ANC) of 300 cells/mm3. What is the diagnosis?
A. Viral Hepatitis
B. Hepatorenal Syndrome
C. Biliary Colic
D. Spontaneous Bacterial Peritonitis (SBP)
Answer: D
